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Case Reports
. 2024 Jun 21;19(1):346.
doi: 10.1186/s13019-024-02865-x.

A rare case of a simultaneous post-dissection saccular aneurysm of the ascending aorta and large pulmonary artery aneurysm with secondary embolism: a case report

S R van Dinter  1 , T Arslan  2   3 , S Boerman  4 , F N Hofman  2 , P Klein  5
Affiliations
Case Reports

A rare case of a simultaneous post-dissection saccular aneurysm of the ascending aorta and large pulmonary artery aneurysm with secondary embolism: a case report

S R van Dinter et al. J Cardiothorac Surg. .

Abstract

Background: Aneurysms of the pulmonary arteries and the ascending aorta are rare, and both bear a high mortality risk if left untreated. In general, these entities are primarily caused by etiologies such as hypertension, pulmonary arterial hypertension, infection or congenital disorders. Treatment requires a rapid diagnostic work-up or even immediate surgical intervention in acute cases. Nevertheless, surgery entails serious perioperative risks, in particular in patients with multiple comorbidities.

Case presentation: We discuss a 70-year-old woman presented with decompensated heart failure based on severe pulmonary artery hypertension, coincided by a massive pulmonary artery aneurysm with secondary embolism. Additional diagnostic imaging also showed a chronic post-dissection, saccular aneurysm of the ascending aorta. To our knowledge, this simultaneous diagnosis of a saccular aneurysm of the ascending aorta and a large aneurysm of the pulmonary artery with secondary embolism has not yet been described. Nonetheless, conservative treatment was chosen due to extensive pulmonal and cardiovascular comorbidities and the high-risk profile of surgery.

Conclusions: Extensive aneurysmatic disease of the pulmonary arteries and ascending aorta come with a serious burden of disease, especially if coincided by severe pulmonal and cardiovascular comorbidities. Both conditions can be curatively treated by surgical intervention. However, in every case the risk of surgery and the patient's vitality, comorbidities and wishes should be taken into account to formulate an adequate treatment plan. Therefore, shared decision making is of utter importance.

Keywords: Aneurysm; Ascending aorta; Dissection; Embolism; Hypertension; Pulmonary arterial hypertension; Pulmonary artery.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Diagnostic work-up imaging with CMR and CT scan of the PAA and PE. Initial CT and CMR scan in the diagnostic work-up regarding the PAA and PE. Figure 1A and B: CT scan with frontal and sagittal view of the transverse aortic arch and left pulmonary artery with pulmonary embolism. Figure 1C and D: CMR and CT scan with transversal view of the aneurysmatic pulmonary trunk, right and left pulmonary artery, as well as the ascending aorta with retrospectively diagnosed saccular post-dissection aneurysm (depicted by *). The arrow indicates calcifications marking the aortic lumen AA = ascending aorta, DA = descending aorta, LPA = left pulmonary artery, PE = pulmonary embolism, PT = pulmonary trunk, RPA = right pulmonary artery, RV = right ventricle, TA = transverse aortic arch
Fig. 2
Fig. 2
Additional CT angiography of the post-dissection aneurysm. A CT angiography scan of the ascending thoracic aorta, showing the saccular post-dissection aneurysm (depicted by *) at the right-sided posterior section of the mid-ascending aorta in coronal (Fig. 2A) and transversal (Fig. 2B) view AA = ascending aorta; DA = descending aorta; LPA = left pulmonary artery; LV = left ventricle; PE = pulmonary embolism; PT = pulmonary trunk; RPA = right pulmonary artery; TA = transverse aortic arch
See this image and copyright information in PMC

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